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Purpose of Review: This work aims to provide an update of knowledge on the evolution of inactive cystic echinococcosis (CE) cysts (CE4-CE5) managed by 'watch-and-wait', by means of a scoping review of the literature published after the publication of the WHO-IWGE (Informal Working Group on Echinococcosis) Expert Consensus document in 2010., Recent Findings: A total of 31 articles were included. Population ultrasound-based studies showed that spontaneously inactivated CE cysts represent 50.2% (95% confidence interval 38.7-61.8) of all detected untreated CE cysts, and that the prevalence of CE4-CE5 cysts tends to increase with age. Four longitudinal population-based studies showed that CE cysts naturally tend to evolve towards inactivation and that spontaneously inactivated cysts reactivate in a minority of cases. This was confirmed by four hospital-based studies, showing that spontaneously inactivated cysts reactivate rarely, while rate of reactivation is higher if inactivity was obtained posttreatment. It was not possible to drive conclusions on any difference in the clinical course of infection in immunocompromised or pregnant patients., Summary: CE cysts tend to evolve spontaneously to inactivation over time. The published literature supports the safety of the watch-and-wait approach for inactive cysts, sparing treatment to a substantial proportion of asymptomatic patients. A regular follow-up with ultrasound of all inactive cysts is required to detect reactivations., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Echinococcus infections are rare in the United States but may present a growing public health threat. We present the case of an 8-year-old female patient from Southern California who was diagnosed with hepatic echinococcosis after the incidental discovery of large hepatic cysts., Competing Interests: The authors have no funding or conflicts of interest to disclose, (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Anaphylaxis is a potentially life-threatening condition caused by a variety of triggers. However, anaphylaxis following an abdominal trauma is an exceptionally rare condition and could be the first and only sign of hepatic hydatid cyst, especially when no obvious etiology is present. Here, we present such a rare case and discuss relevant diagnostic and management strategy in light of the literature., Case Report: This case report refers to a 17 year-old previously healthy girl admitted in our pediatric emergency department (ED) for syncope after a minor blunt abdominal trauma. She was hypotensive on admission and shortly after she developed urticaria and angioedema. She was diagnosed with anaphylaxis and treated immediately. Possible etiologies including drug or food ingestion, insect bite, and previous allergy/anaphylaxis history were excluded. After stabilization abdominal imaging was performed, which revealed a ruptured large hepatic hydatid cyst in the vicinity of biliary tree. Albendazole treatment was started and surgical resection was performed after clinical stabilization, which confirmed the cyst rupture into the biliary ducts. Patient recovered without complications after surgery and was discharged uneventfully., Conclusion: This case report highlights that hydatid cyst rupture should be included in the differential diagnosis of anaphylaxis without obvious etiology, particularly in regions where hydatid disease is endemic. Ruptured hydatid cyst leading to anaphylaxis requires timely diagnosis, management and emergent intervention., (© 2022. The Author(s).)

Background: The diagnosis of cystic echinococcosis (CE) is primarily based on imaging, while serology should be applied when imaging is inconclusive. CE cyst stage has been reported among the most important factors influencing the outcome of serodiagnosis. We performed a systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests, to evaluate whether their relation is a consistent finding and provide guidance for the interpretation of results of serological tests., Methodology/principal Findings: MEDLINE, EMBASE, CENTRAL, and Lilacs databases were searched on December 1st 2019. Original studies published after 2003 (year of publication of the CE cyst classification), reporting sensitivity of serological tests applied to the diagnosis of human hepatic CE, as diagnosed and staged by imaging, were included. The quality of studies was assessed using the Newcastle-Ottawa Scale. Data from 14 studies were included in the meta-analysis. Summary estimates of sensitivities and 95% confidence intervals were obtained using random effects meta-analysis. Overall, test sensitivity was highest in the presence of CE2 and CE3 (CE3a and/or CE3b), and lowest in the presence of CE5 and CE4 cysts. ELISA, ICT and WB showed the highest sensitivities, while IHA performed worst., Conclusions/significance: The results of our study confirm the presence of a clear and consistent relation between cyst stage and serological tests results. Limitations of evidence included the heterogeneity of the antigenic preparations used, which prevented to determine whether the relation between cyst stage and sensitivity was influenced by the type of antigenic preparation, the paucity of studies testing the same panel of sera with different assays, and the lack of studies assessing the performance of the same assay in both field and hospital-based settings. Our results indicate the absolute need to consider cyst staging when evaluating serological results of patients with hepatic CE., Competing Interests: The authors have declared that no competing interests exist.

Introduction:  The prevalence of alveolar echinococcosis (AE) and cystic echinococcosis (CE) in Germany is increasing. The number of cases in northern and eastern regions is low, so there is little experience with regard to diagnosis and therapy., Objectives:  The objective of this paper was to evaluate the management of suspected and/or diagnosed echinococcosis at a university center in a low-prevalence region., Methods:  All the patients at the Leipzig University Hospital between 2004 and 2018 who had been serologically examined for echinococci were included in a retrospective cohort study. Clinical course, imaging, histology, therapeutic characteristics, relevant comorbidities and risk factors for AE and CE were evaluated. A time-staggered prevalence estimation, as well as sensitivity and specificity calculations for the serological tests, were performed., Results:  A total of 382 patients were enrolled, with 11 AE and 7 CE cases identified. The mean prevalence rate of AE in this cohort was 2.9 % and that of CE was 1.8 %. Among the patients, 56 % had known risk factors for AE and CE. The serological tests showed a sensitivity of 86 % and a specificity of 91 %. Two patients with false-negative serology were diagnosed by biopsy. All CE and 5 AE patients (45 %) were operated on. Six AE patients received long-term treatment with albendazole., Conclusions:  AE and CE are rare diseases in the greater Leipzig region; however, case numbers are on the rise. Due to favorable factors such as the escalation of migration, a further increase is expected. Diagnosis and therapy are challenging and should be supported by specialists (experienced infectiologists, imaging experts and skilled hepatobiliary surgeons) who should be integrated in a German network., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Alveolar echinococcosis (AE) is one of the most lethal parasitic zoonoses in the Northern Hemisphere, and early serological detection is important to start treatment and to improve survival. A total of 50 sera samples of patients diagnosed as having various diseases were examined for by two different serological diagnostic methods., Methods: Em2-Em18 ELISA (Bordier Affinity Products, Crissier, Switzerland) and Echinococcus Western Blot immünoglobulin G (IgG) (LDBIO Diagnostics, Lyon, France) were used for analyisis., Results: A high titer of antibodies was found in 9 of 10 patients diagnosed as having AE with Em2-Em18 ELISA, in 2 of 21 patients with cystic echinococcosis, in 1 of 2 patients with fascioliasis and in 1 patient with chronic hepatitis. The Echinococcus Western Blot IgG test, used as a confirmatory test, showed IgG antibody in 85.7% (18/21) of patients with CE, while all serum samples of 10 patients with AE were evaluated as positive. This method yielded an incorrect diagnosis in the patient with chronic hepatitis and in the patient with granulomatous inflammation with caseification. Samples taken from patients with liver-related diseases and other parasitic-related diseases were found to be negative., Conclusion: The serological methods used in the study were found to be important in the early diagnosis of alveolar echinococcosis in the endemic areas, since it could be used in sero-epidemiological studies.

A 23-yr-old captive-born Przewalski's horse mare ( Equus przewalskii) was euthanized at a Canadian zoo because of severe colic resulting from rupture of a jejunal pseudodiverticulum. An incidental finding of an encysted larval cestode within a hepatic granuloma was diagnosed on histopathology. Gel-based polymerase chain reaction (PCR) on liver tissue was positive for Echinococcus granulosus sensu lato, and deoxyribonucleic acid sequencing of the PCR product was 100% homologous with Echinococcus equinus. This appears to be the first molecular confirmation of E. equinus in North America, and the first report of cystic echinococcosis in a Przewalski's horse.

Among the species composing the genus Echinococcus, four species are of human clinical interest. The most prevalent species are Echinococcus granulosus and Echinococcus multilocularis, followed by Echinococcus vogeli and Echinococcus oligarthrus. The first two species cause cystic echinococcosis (CE) and alveolar echinococcosis (AE) respectively. Both diseases have a complex clinical management, in which laboratory diagnosis could be an adjunctive to the imaging techniques. To date, several approaches have been described for the laboratory diagnosis and followup of CE and AE, including antibody, antigen and cytokine detection. All of these approaches are far from being optimal as adjunctive diagnosis particularly for CE, since they do not reach enough sensitivity and/or specificity. A combination of several methods (e.g., antibody and antigen detection) or of several (recombinant) antigens could improve the performance of the adjunctive laboratory methods, although the complexity of echinococcosis and heterogeneity of clinical cases make necessary a deep understanding of the host-parasite relationships and the parasite phenotype at different developmental stages to reach the best diagnostic tool and to make it accepted in clinical practice. Standardization approaches and a deep understanding of the performance of each of the available antigens in the diagnosis of echinococcosis for the different clinical pictures are also needed. The detection of the parasite in definitive hosts is also reviewed in this chapter. Finally, the different methods for the detection of parasite DNA in different analytes and matrices are also reviewed., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The diagnosis of cystic echinococcosis (CE) is based primarily on imaging, in particular with ultrasound for abdominal CE, complemented by serology when imaging results are unclear. In rural endemic areas, where expertise in ultrasound may be scant and conventional serology techniques are unavailable due to lack of laboratory equipment, Rapid Diagnostic Tests (RDTs) are appealing., Methodology/principal Findings: We evaluated the diagnostic accuracy of 3 commercial RDTs for the diagnosis of hepatic CE. Sera from 59 patients with single hepatic CE cysts in well-defined ultrasound stages (gold standard) and 25 patients with non-parasitic cysts were analyzed by RDTs VIRapid HYDATIDOSIS (Vircell, Spain), Echinococcus DIGFA (Unibiotest, China), ADAMU-CE (ICST, Japan), and by RIDASCREEN Echinococcus IgG ELISA (R-Biopharm, Germany). Sensitivity, specificity and ROC curves were compared with McNemar and t-test. For VIRapid and DIGFA, correlation between semiquantitative results and ELISA OD values were evaluated by Spearman's coefficient. Reproducibility was assessed on 16 randomly selected sera with Cohen's Kappa coefficient. Sensitivity and Specificity of VIRapid (74%, 96%) and ADAMU-CE (57%, 100%) did not differ from ELISA (69%, 96%) while DIGFA (72%, 72%) did (p = 0.045). ADAMU-CE was significantly less sensitive in the diagnosis of active cysts (p = 0.019) while DIGFA was significantly less specific (p = 0.014) compared to ELISA. All tests were poorly sensitive in diagnosing inactive cysts (33.3% ELISA and ADAMU-CE, 42.8% DIGFA, 47.6% VIRapid). The reproducibility of all RDTs was good-very good. Band intensity of VIRapid and DIGFA correlated with ELISA OD values (r = 0.76 and r = 0.79 respectively, p<0.001)., Conclusions/significance: RDTs may be useful in resource-poor settings to complement ultrasound diagnosis of CE in uncertain cases. VIRapid test appears to perform best among the examined kits, but all tests are poorly sensitive in the presence of inactive cysts, which may pose problems with accurate diagnosis.

Echinococcus alveolaris (EA) causes a hepatic zoonotic infection and behaves like a malignant tumor during invasion. Liver transplantation (LT) is the only curative treatment option for this unresectable disease. Here, we share our experience with living donor liver transplantation (LDLT) due to EA from the time between March 2002 and November 2014 at the Liver Transplantation Institute of İnönü University. Ten patients (mean age, 38.6 years) undergoing LDLT because of unresectable EA were evaluated preoperatively, and the operative and follow-up data were analyzed retrospectively. The mean time interval between diagnosis and LT was 27 months. The mean operation time and mean intraoperative blood requirement were 613 minutes and 4 units of packed red blood cells, respectively. Diaphragmatic resections were performed in 3 patients, and vena cava replacement was performed in 2 patients because of difficulties in removing the extended disease. The local recurrence and distant metastasis rates were 10% and 20%, respectively. The mean survival time was 19.5 months (range, 0-54 months), and the mortality rate was 30%. Unresectable hepatic alveolar echinococcosis is a rare indication for LT and presents some technical difficulties during surgery because diaphragmatic resection, vascular reconstruction, or multiple blood transfusions may be needed. LDLT can be performed successfully in patients with this rare infectious disease, with careful follow-up for potential recurrence and metastasis and administration of low-dose immunosuppressive agents., (© 2015 American Association for the Study of Liver Diseases.)

Echinococcus alveolaris is a parasite from tenia family which causes tumor-like lesions in the livers of infected people. If it is not diagnosed in the early stage of the disease, it frequently causes multiple cysts in the liver. The clinical importance of the disease is rapid progression, infiltration into different tissues like a malignant tumor and capacity of creating metastatic masses. The disease could be treated either by surgical resection or liver transplantation. The resection of the cystic disease is the preferred treatment method. In cases where resection is not possible, liver transplantation is the choice of treatment. Here we present three cases which were admitted to the hospital with unresectable hepatic alveolar echinococcosis and treated by liver transplantation successfully. Patients for whom surgical resection is not possible, we recommend liver transplantation as the treatment method.

Human alveolar echinococcosis (AE) is a lethal parasitic infectious disease which may lead to liver failure if left untreated. It is caused by the larval stage of the fox tapeworm Echinococcus multilocularis and usually develops a substantial infiltrative occupation in solid organs. During the infection, T helper subsets are known to play crucial role in crosstalk between the parasite and human host. Th9 cells, a new member of CD4(+) T cell family which is characterized by its specific cytokine IL-9 and transcription factors PU.1 and IRF-4, have been known recently to have a critical role in allergic diseases, and cancers as well as the parasitic infection. To assess the potential role of Th9 cells during the infection, the mRNA levels of IL-9, PU.1, and IRF-4 both in peripheral blood mononuclear cells and in liver tissues were, respectively, detected by using real-time PCR. The plasma concentration levels of IL-9 were detected by using enzyme linked immunosorbent assay (ELISA). Th9 related cytokine IL-9 and transcription factors PU.1 and IRF-4 mRNA levels elevated both in PBMCs, and in hepatic lesion and paralesion tissues in AE patients. This may facilitate the infiltrative growth of the parasite and its persistence in human host.

Background: Cystic echinococcosis (CE) is a globally distributed cestode zoonosis that causes hepatic cysts. Although Echinococcus granulosus sensu stricto (s.s.) is the major causative agent of CE worldwide, recent molecular epidemiological studies have revealed that E. canadensis is common in countries where camels are present. One such country is Mongolia., Methodology/principal Findings: Forty-three human hepatic CE cases that were confirmed histopathologically at the National Center of Pathology (NCP) in Ulaanbaatar (UB) were identified by analysis of mitochondrial cox 1 gene as being caused by either E. canadensis (n=31, 72.1%) or E. granulosus s.s. (n=12, 27.9%). The majority of the E. canadensis cases were strain G6/7 (29/31, 93.5%). Twenty three haplotypes were identified. Sixteen of 39 CE cases with data on age, sex and province of residence were citizens of UB (41.0%), with 13 of the 16 cases from UB caused by E. canadensis (G6/7) (81.3%). Among these 13 cases, nine were children (69.2%). All pediatric cases (n  =  18) were due to E. canadensis with 17 of the 18 cases (94.4%) due to strain G6/7. Serum samples were available for 31 of the 43 CE cases, with 22 (71.0%) samples positive by ELISA to recombinant Antigen B8/1 (rAgB). Nine of 10 CE cases caused by E. granulosus s.s. (90.0%) and 13 of 20 CE cases by E. canadensis (G6/7) (65.0%) were seropositive. The one CE case caused by E. canadensis (G10) was seronegative. CE cases caused by E. granulosus s.s. showed higher absorbance values (median value 1.131) than those caused by E. canadensis (G6/7) (median value 0.106) (p  =  0.0137)., Conclusion/significance: The main species/strains in the study population were E. canadenis and E. granulossus s.s. with E. canadensis the predominant species identified in children. The reason why E. canadensis appears to be so common in children is unknown.

Echinococcosis of the CNS is very rare. Cystic (CE) and alveolar echininococcosis (AE) vary in their clinical manifestations, course of disease, and prognosis, to the extent that clinicians should look at these two parasitic infections as distinctly different entities. CE causes displacement and pressure atrophy, while AE expands by infiltrative growth. Due to the embolic nature of CE and AE, CNS lesions are most commonly localized supratentorially in the middle cerebral artery. Symptoms and clinical signs are those of space-occupying lesions. Diagnosis is primarily based on imaging (MRI, CT); serology can help to confirm the diagnosis, but is unreliable. In vivo MRS techniques for immobile intracranial CE lesions have become feasible and will assist in diagnosing such lesions in the future. Patients with cerebral CE and AE need an individual therapeutic approach and should generally be managed by a multidisciplinary team of clinicians experienced in the management of CE and neurosurgeons. A minimum follow-up of 5 years, but ideally 10 years, is necessary. Treatment is difficult in advanced disease, in particular in AE, when curative surgery is not possible. AE and CE are among the most neglected infectious diseases and urgently need more attention to improve early detection in exposed populations, diagnosis, and treatment., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Cystic echinococcosis (CE) is a major parasitosis in Romania, a country where in the past at least one person from 45.5% of its localities underwent surgery for this disease. This survey aimed to provide new epidemiological and clinical data regarding human cases of CE in a western Romanian county. We have retrospectively investigated the medical records of the patients with CE hospitalized during the period of 2004-2010 in the surgical sections of Arad County. A total of 79 patients aged 5-88 years (mean age: 35.9±20.1 years) were diagnosed with CE during the study period. The average yearly incidence was 2.4 cases per 100,000 inhabitants, and the majority of the patients (29.1%) were aged 0-19 years. Most of the adult cases (≥18 years) were people with limited formal education (laborers) (45.6%). The analysis for trend showed an overall decrease in the affected persons over the study period (R(2)=0.66, p=0.026). Hepatic localizations of the hydatid cysts predominated within the study group (73.4%). Only 21.5% of the diseased presented complications and the mean length of hospital stay was 16.2±10.9 days. Eosinophilia of at least 10% of the leukocyte value occurred in 14% of cases and leukocytosis was noticed in 24.1% of patients. Although the rates of CE cases have decreased in Arad County (Romania), this parasitic disease continues to be a concern for public health services and requires the implementation of more stringent prophylactic measures.

Unlabelled: The study objective was to assess the prevalence of human cystic echinococcosis in Poland in 2010, as compared with the number of registered cases in 2009, and former years., Materials and Methods: Evaluation of epidemiological situation was based on the analysis of data published in the annual bulletin Infectious diseases and poisonings in Poland in 2010, M. Czarkowski et al., National Institute of Public Health - National Institute of Hygiene, Chief Sanitary Inspectorate. In addition, the data on taeniases provided to the Department of Medical Parasitology NIPH-NIH by regional sanitary-epidemiological stations were analyzed., Results: 36 cases of echinococcosis (incidence 0.09) were recorded in 2010: 34 cases caused by Echinococcus granulosus (incidence 0.09) and 2 cases triggered by Echinococcus multilocularis (incidence 0.005). There was a slight increase in the incidence of cystic echinococcosis as compared to the preceding year (25 cases in 2009, incidence 0.07). Most cases were reported in the Masovian province (12 cases, 33.3% of all reported cases, incidence 0.23), and the smallest number in the Kuyavian-Pomeranian province (1 case, incidence 0.05). More cases of echinococcosis (25 cases, 69.44%) were recorded in the countryside than in cities (11 cases, 30.56%). Both, in the rural and urban areas, women suffered more frequently (31 cases, 86.11%) than men (5 cases, 13.89%). Multilocular echinococcosis was diagnosed in one woman and one man from the countryside. 26 patients (72.2%) were hospitalized in 2010, which indicates a decline in the percentage of hospital admissions as compared to previous years: 100% of patients were hospitalized in 2008, and 92% in 2009. There were no reported cases of cysticercosis., Conclusions: It is essential to continually propagate information relative to infection cystic echinococcosis in human in Poland.

Echinococcus multilocularis (EM) is caused by the larval stage of the tapeworm. The main endemic regions for human alveolar echinococcosis are Central Europe, Russia, Turkey, Japan, China, Eastern France, North America. EM is an endemic disease in Turkey and especially common in the eastern Anatolia Region as seen in our case. The liver is the primary focus of the disease, cerebral localization is rare. Cerebral hydatid disease is approximately 5% of alveolar hydatid cases and generally considered to be fatal. Surgical treatment should be considered whenever possible. We present a case of cerebral alveolar hydatid disease that was thought to be cerebral metastasis.

We describe the case of a 14-year-old boy of Turkish origin, presenting with anaphylactic shock after a minor abdominal trauma. Further investigations revealed a hepatic Echinococcal cyst without evidence of rupture. Anti-helminthic therapy was administered. Because of aggravating symptoms and recurrent anaphylaxis, surgical excision was performed. Intra-operative, a rupture into the biliary tree was seen. After surgery, the anaphylactic symptoms disappeared and the patient recovered. This case-report supports the fact that anaphylactic shock can be the only presentation of a hydatid cyst. Microscopic spillage can possibly be sufficient to cause major anaphylaxis.

In 2003-2010 5483 persons suspected of echinococcosis were examined for Echinococcus granulosus and Echinococcus multilocularis infections using serological tests in the Department of Medical Parasitology National Institute of Public Health - National Institute of Hygiene. The screening test ELISA (Bordier Affinity Products S. A.), confirmation tests Western-blot (LDBIO Diagnostics, Lyon-France) and ELISA Em2 plus (Bordier Affinity Products S.A) were applied. Within 235 persons posistive for in screening test, 162 were confirmed with Echinococcus granulosus and 33 - E. multilocularis. In 40 cases the tests failed to determine the Echinococcus species. In the period of 2006-2010 the linear decrease of percentage of positive results was observed. However, the information about the continuously growing population of red fox in Poland, together with the growing percentage of the animals infected with E. multilocularis, suggests the need for continuous monitoring of human alveococcosis.

We analyze the clinical data and the possible methods for diagnostics of liver echinococcosis. The most common clinical manifestations are: burden, dull or colic pain in right hypochondrium, hepatomegaly plus. Against this clinical picture available eosinophilia is indicative sign in the diagnostic process; echography is binding method in the study. Establish the possibilities of each diagnostic method individually and in combination. It is recommended that the application of ultrasound in combination with the immunological method, which combined in 9/10 of the patients decided to avoid diagnosis and diagnostic polipragmatic approach. The other, considerably more expensive and radiological overdosing methods must be applied in exceptional cases. In every manifestation of allergy must be investigation to exclude the echinococcosis. We highly recommended the introduction in Bulgaria of screening methods for early detection of disease and timely treatment.

Introduction: Especially debatable remains the problem concerning the volume of the surgical treatment of hepatic echinococcosis. At present it varies from radical typical and atypical liver resections, through closed conservative approaches, to minimally invasive methods like PAIR or laparoscopic echinococcectomy., Aim: The aim of the present investigation is to elucidate the problems, occurring during surgical treatment of hepatic echinococcosis and to offer adequate treatment-diagnostic algorithm. This retrospective study summarizes our 10-year experience in a number of debatable topics, concerning the surgical treatment of this socially significant disease., Results: To fulfill the aim, we performed a retrospective clinical study for a period of 10 years. One-hundred-forty-seven patients had been admitted to hospital and underwent surgical treatment for hepatic echinococcosis during that period. One-hundred were males (58%) and 47 (32%)--females. The age of the patients included in the retrospective study varies between 6 and 80 years--(mean age 39.1 +/- 8.9). In 19 patients we found multiple echinococcosis of the liver (2 to 7 cysts). Two cysts--in 7 patients, 3 cysts--in 6 patients, 4 cysts in 1 patient, 5 cysts in 2 patients, 6 cysts in 1 patient and 7 cysts in 2 patients. The right hepatic lobe is three times more frequently engaged than the left one--106 patients with right-sided localization (72.1%) compared to 41 with left-sided (27.9%). Combined echinococcosis is found in 14 patients. Concomitant engagement of liver and spleen is present in 2 patients, peritoneal dissemination--in 7 patients and accompanying lung cyst--in 6 patients. Echinococcectomy with capitonage of the residual cavity is performed in 126 patients, echinococcectomy with external drainage in 4 patients, atypical liver resection in 8 patients, echinococcectomy via thoracofrenectomy approach in 6 patients and combined surgical interventions with spleen removal in 3 patients. In their majority the complications are not serious and life-threatening or with permanent consequences to the patient. Severe complications demanding active surgical intervention occur in approximately 4% of the treated patients. Our results are comparable with the ones of leading national and foreign centers and confirm the correctness of our treatment. The average hospital stay is 12 days. We have no lethal cases for the study period., Conclusion: Based on our experience, we consider that echinococcectomy with capitonage of the residual cavity and invagination of the fibrous rims is the method of choice for hepatic localization of the parasite. The above-mentioned surgical technique is characterized with low percentage of post-surgical complications, is well-tolerated from patients and relatively atraumatic and shows excellent long-term results. We consider more radical surgical methods, like atypical liver resections, appropriate in selected patients, ones with multiple echinococcosis and vast fibrous-altered areas of liver parenchyma. We find reasonable the obligatory adjuvant post-surgical treatment with Albendazole under parasitologist control, especially in cases of multiple and/or recurrent echinococcosis.

Introduction: The adequate treatment for hydatidosis requires a knowledge of certain aspects related to the survival of infectious agents, especially protoscoleces. The aim of this study is to evaluate the viability of protoscoleces in human hepatic hydatid cysts in order to determine the prevalence of their fertility and to study the association with variables typical of the host and of the parasite., Materials: A cross-sectional study was done in biological material (the fluid from human hepatic hydatid cysts). The viability criteria used were: ovoid form, invaginated scolices and intact calcareous corpuscles, the presence of vibrating movements, and the absence of "vital" staining. The cysts were grouped as univesicular cysts (UVC), multivesicular cysts (MVC) and abscessed cysts (LAHO). Fertility was defined as living protoscoleces in relation to the total number of protoscoleces. Descriptive statistics were for the calculation of the prevalence of fertility, analytical statistics for the comparison of groups, and a multivariate analysis for the examination of the association between cyst fertility and clinical variables., Results: A total of 163 cysts with a median diameter of 15 cm were studied in this way. Of these lesions, 79 (48.5%) were UVC, 54 (33.1%) MVC, and 30 (18.4%) LAHO. On 99 occasions (60.7%), macroscopic communication was evident in the bile duct, and a prevalence of general fertility of 57.1% (94.4% for MVC, 53.2% for UVC, and 0% for LAHO, with a value of P<0.001). Association with location, type, and diameter of the cyst, and presence of biliary communications was verified by applying a bivariate analysis, and association between fertility and the variables of the type of the cyst and the existence of biliary communications was verified employing a multivariate analysis (P values of 0.004 and <0.001, respectively)., Conclusions: The prevalence of fertility found was low. The main prevalence of fertility was observed in MVCs. Fertility is associated with the type of cyst and the presence of biliary communications.

This study describes, for the first time, the characterization of excretory-secretory antigens (ES-Ag) from Echinococcus granulosus protoscoleces, evaluating their usefulness in the immunodiagnosis of human cystic echinococcosis. ES-Ag were obtained from the first 50 h maintenance of protoscoleces in vitro. This preparation contained over 20 major protein components which could be distinguished by 1-dimensional SDS-PAGE with apparent masses between 9 and 300 kDa. The culture of of protoscoleces from liver produced a greater variety of excretory-secretory protein components than those from lung. Determination of enzymatic activities of secreted proteins revealed the presence of phosphatases, lipases and glucosidases, but no proteases. These findings were compared to those obtained from somatic extracts of protoscoleces and hydatid cyst fluid products. Immunochemical characterization was performed by immunoblotting with sera from individuals infected by cystic echinococcosis (n = 15), non-hydatidic parasitoses (n = 19), various liver diseases (n = 24), lung neoplasia (n = 16), and healthy donors (n = 18). Antigens with apparent masses of 89, 74, 47/50, 32, and 20 kDa showed specificity for immunodiagnosis of human hydatidosis. The 89 and 74 kDa components corresponded to antigens not yet described in E. granulosus, whereas proteins of 41-43 kDa and 91-95 kDa were recognized by the majority of the non-hydatid sera studied.

Human alveolar echinococcosis, caused by the metacestode stage of Echinococcus multilocularis, is one of the most dangerous zoonoses in the temperate and arctic areas of northern hemisphere. The mortality of the disease exceeds 95% in untreated or inadequately treated patients. In the past three decades, the spread of this parasite was observed in Europe as a consequence of human interventions resulting in the population size increase of foxes. The authors demonstrated the presence of E. multilocularis in foxes in all northern counties of Hungary and the existence of hyperendemic regions in the Counties Nógrád and Gyor-Moson-Sopron. The aim of the present paper is to summarize the current knowledge on the life cycle and distribution of E. multilocularis, and the epidemiology, clinical features, diagnosis, treatment and control of human alveolar echinococcosis.

The aim of this retrospective study is to report on a series of 15 patients with abdominal hydatid disease in uncommon sites submitted to surgery in our unit over the period 1974-2003. Eight women and 7 men (mean age: 48.4 years) were included in the study. The hydatid cysts were located in the peritoneum in 8 patients, in the spleen in 5, in the kidney in 1 and in the retroperitoneum in 1. In 4 cases the peritoneal cysts were solitary, while 4 patients in this subgroup presented multiple cysts and 2 had concomitant liver hydatidosis. The splenic cysts were solitary in 2 cases, associated with a hepatic cyst in 2 and with a lung cyst in 1. The renal and retroperitoneal cysts were both solitary. The diagnosis was made at operation in 3 cases, while in 12 patients it was made by serological tests, ultrasonography and/or CT. All patients were operated on: we performed a total cystectomy in 7 patients with peritoneal cysts and in the patient with a retroperitoneal location, splenectomy in the 5 splenic cysts and a partial cystectomy with external drainage of the residual cavity in 1 peritoneal cyst and in the renal location. The postoperative course was regular with no mortality and no major morbidity in 14 patients, while 1 patient submitted to splenectomy developed a subphrenic abscess that required surgical drainage. Two recurrences occurred in patients with peritoneal cysts 71 and 20 months, respectively, after the first operation and these were managed by total cystectomy. The diagnosis of uncommon abdominal sites of hydatid disease is more accurate today because of the new imaging techniques, which are often able to show specific radiological signs of hydatid disease. The treatment of choice is surgical and complete removal of the cyst is the gold standard, but its feasibility is related to the location of the cyst.

We report a human case of polycystic hidatidosis due to Echinococcus vogeli from Contamana (Department of Loreto) village located in the central jungle of Peru. The patient is a 44 year-old lady, teacher, who carried a painless liver mass since a year ago. She was submitted to abdominal surgery and the liver mass was removed and showed multiple cysts containing colorless liquid as is showed in the polycystic hidatidosis. The morphology and measure of the hooks obtained from the liquid contained in the cysts are from Echinococcus vogeli. It is the first report of this parasitism in Perú.

Infections of humans with Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE), a zoonosis, have been described with increasing frequency in Poland since 1994. In the attempt to verify these reports, we analyzed specimens obtained from a representative group of Polish patients. Liver lesions in patients with AE that was diagnosed on the basis of results of histological and serological tests contained E. multilocularis DNA, as shown by the presence of specific microsatellite sequences and mitochondrial 12S rDNA. The same tests clearly distinguished between AE and cystic echinococcosis, which is caused by Echinococcus granulosus. These data are unequivocal proof that human infections with E. multilocularis occur in Poland.

The species identification of an echinococcal lesion in the liver of a yak in the Qinghai-Tibet plateau region of China, where both Echinococcus granulosus and E. multilocularis are present, was difficult to determine because of the atypical appearance of the lesion. Polymerase chain reaction-based mitochondrial genotyping allowed us to discriminate the Echinococcus species. Nucleotide sequences of the cytochrome c oxidase subunit 1 (cox1) and cytochrome b (cytb) genes amplified from the echinococcal lesion demonstrated that the yak was infected with the E. granulosus G1 genotype (sheep strain).

To further evaluate recombinant Em18 antigen (rEm18) for immunodiagnosis of human alveolar echinococcosis, 208 serum samples were examined by enzyme-linked immunosorbent assay (ELISA). To comparatively assess the results of rEm18-ELISA, ELISA and immunoblot analysis with two affinity-purified native antigens were also performed with 45 selected serum samples. The results indicate that rEm18 is highly useful for serodiagnosis.

Latex agglutination test (LAT) was standardized and evaluated to detect hydatid antigen in fluid samples aspirated from 6 surgically proved human cases of cystic echinococcosis (CE), 4 suspected human cases of CE (2 cases of cysts in the liver which were not confirmed surgically and 2 cases of pelvic cysts later confirmed as abscesses) and 7 cases of hydatid cysts of liver in cattle. Echinococcus granulosus scolices and hook lets were seen in aspirated fluid by microscopy and the characteristic germinal layer of the cyst wall was demonstrated by histopathology in 6 human hydatid cysts operated and removed by surgery. In case of cattle hydatid liver cysts no scolices or hook lets were seen in aspirated fluid as they were sterile cysts but characteristic laminated layer of the cyst wall was demonstrated by histopathology of these cysts. The LAT could detect antigen in fluid samples collected from all 6 human cases of surgically proved CE and 7 cases of hydatid cyst liver in cattle, thus showing sensitivity of 100%. The LAT could detect antigen in fluid samples collected from 2 suspected cases of CE liver in humans, which were not operated. The LAT was found to be specific. No cross reactivity was observed. The results of the study showed that LAT could be employed as a simple and rapid diagnostic procedure, as an alternate to microscopy, to confirm the hydatid etiology of a suspected cyst.

Extensive experience has documented that Em2(plus)-ELISA, Em10-ELISA and Em18-immunoblot and Em18-ELISA are reliable serologic methods for detection of alveolar echinococcosis (AE) caused by the metacestodes of Echinococcus multilocularis. Among these, tests based on detection of antibodies to the specific Em18 antigen, either immunoblot or ELISA, appears to be the most specific for AE. Between 90 and 97% of AE cases with characteristic hepatic lesions detectable by image analysis have been positive in Em18-serology. In contrast Antigen B (8 kDa)-immunoblot is the most sensitive for all forms of echinococcosis, although it can not differentiate AE from cystic echinococcosis (CE). Primary serologic screening for echinococcosis, especially for CE using hydatid cyst fluid of Echinococcus granulosus appears to be highly sensitive in endemic areas. Glycoproteins (GPs) purified from cyst fluid of Taenia solium are highly specific for diagnosis of T. solium neuorcysticercosis (NCC). Using currently available antigens it is not difficult to differentiate these three larval cestodiases serologically. We recommend that (1) primary screening of CE in endemic areas should be carried out using hydatid cyst fluid of E. granulosus prepared from cysts in either sheep, human or mouse for immunoblot and from sheep or mouse for ELISA, (2) both primary screening and confirmation of AE in endemic areas should be carried out using Em18-ELISA, Em18-immunoblot or Em2(plus)-ELISA. Serodiagnosis in areas where both AE and CE are endemic, such as in China, should be carried out as a combination of (1) and (2), and (3) serology of NCC should be carried out using GP-ELISA or GP-immunoblot. All samples showing antibody to Em18 are exclusively from echinococcosis cases. There have been no false positive test reactions with sera from other diseases. Strongest Em18 responders are all from patients with AE but some weaker responses may be found in sera of persons with advanced complex lesions of CE. These highly reliable serodiagnostic methods using native, recombinant and synthetic antigens are briefly summarized and experiences with these methods in Japan is reviewed. We believe that use of these specific antigens in screening and confirmation programs for AE in Japan will improve specificity and reduce the confusion, anxiety and expense in persons whose sera give false positive reactions with crude echinococcal antigens.

Two cases of Polycystic hydatid disease (PH) are reported from the same municipal district of the Brazilian Amazon region (Sena Madureira, Acre). Both had a similar clinical presentation and course over two years of follow-up. Initially the patients complained of pain in the right hypochondrium or upper abdomen and presented obstructive jaundice, fever, increased abdominal volume and weight loss. By image analysis, in addition to splenomegaly, multiple and coalescent cysts were detected in the liver. Serum samples were reactive by counterimmunoelectrophoresis. Treatment with albendazole resulted in partial improvement, with symptomatic relief and reduction in size of the lesions. This report stresses the importance of performing clinical-epidemiological studies of polycystic hydatid disease in the Brazilian Amazon and especially in the municipality of Sena Madureira where many other cases of PH may remain undiagnosed.

Alveolar echinococcosis (AE) is the most potentially lethal parasitic zoonosis of the nontropical areas in the northern hemisphere, where cystic echinococcosis (CE) is also endemic. Both AE and CE are highly endemic in China, and both serologic detection of echinococcosis, either AE or CE, and differentiation of AE from CE are crucial problems. Evaluation of Western blot analysis (WB) and enzyme-linked immunosorbent assay (ELISA) for the Em18 antigen, using affinity-purified and recombinant Em18, was carried out "blindly" using 60 human sera from patients diagnosed in France. The results were compared with those obtained using a commercially available Echinococcus WB immunoglobulin G (IgG) kit developed in France. The Em18 WB and Echinococcus WB IgG showed very similar results for detection of AE. Both affinity-purified Em18 or a recombinant Em18 WB and Echinococcus WB IgG seem useful for identification of AE, and the latter seems appropriate for both AE and CE, whereas affinity-purified Em18 ELISA and the newly developed recombinant Em18 ELISA appear to be suitable for detection of AE, especially for epidemiological surveys.

The incidence was assessed of antibodies against E. granulosus and chosen biochemical parameters among the inhabitants of north-eastern Poland. Among 532 studied subjects, 110 were seropositive. Group I (n = 73) was pharmacologically treated. Group II was surgically treated. Control group consisted of 15 healthy persons. 20.6% seropositive inhabitants of north-east Poland indicate that echinococcosis is not rare. Mainly it was echinococcosis of the liver, only in 2.7% it was connected with other organs. Echinococcosis was diagnosed among women aged 47-70, living in town, in majority owners of a dog. The course of echinococcos in majority cases was without clinical signs. In the diagnosis USG and serological test were helpful. Laboratory findings were not characteristic of echinococcosis. If it is possible surgical treatment is recommended for removal of parasite, verification of preoperative tests. In majority of chirurgically removed cyst, antibodies against E. granulosus were found after 3.5 years on the average, what evidenced strong immunogenicity of the parasite.

The Echinococcus multilocularis protein Em18 is one of the most promising antigens for use in serodiagnosis of alveolar echinococcosis in human patients. Here we identify an antigenic relationship between Em18 and a 65-kDa immunodominant E. multilocularis surface protein previously identified as either EM10 or EmII/3. The NH(2)-terminal sequence of native Em18 was determined, revealing it to be a fragment of EM10. Experiments were undertaken to investigate the effect of proteinase inhibitors on the degradation of EM10 in crude extracts of E. multilocularis protoscoleces. Em18 was found to be the product of degradation of EM10 by cysteine proteinase. A recombinant Em18 (RecEm18, derived from (349)K to (508)K of EM10) was successfully expressed by using Escherichia coli expression system and then evaluated for use in serodiagnosis of alveolar echinococcosis. RecEm18 was recognized by 27 (87.1%) and 28 (90.3%) of 31 serum samples from clinically and/or pathologically confirmed alveolar echinococcosis patients by enzyme-linked immunosorbent assay and immunoblotting, respectively. Of 33 serum samples from cystic echinococcosis patients, 1 was recorded as having a weak positive reaction to RecEm18; however, none of the serum samples which were tested from neurocysticercosis patients (n = 10) or healthy people (n = 15) showed positive reactions. RecEm18 has the potential for use in the differential serodiagnosis of alveolar echinococcosis.

Before 1999, clinical experience demonstrated that the sylvatic (or Northern) biotype of Echinococcus granulosus seen in Alaska produced fewer complications and serious sequelae than infection with the pastoral (or European) biotype found in other parts of the world. Two cases of E. granulosus with severe sequelae occurred in Alaska in 1999. The adverse outcomes could have been rare complications that are part of the clinical spectrum of disease caused by sylvatic cystic echinococcus, an indication that the sylvatic biotype, especially when affecting the liver, has potential for severe clinical consequences, or perhaps in one case, infection with a more virulent biotype of E. granulosus contracted during visits to Washington State.

The present case report refers to a patient from the State of Rondônia, North region of Brazil, attended with clinical suspicion of hepatic echinococcosis. Examination by imaging (ultrasonography and computerized tomography) revealed a conglomerate of cystic lesions, with mobile contents within the cyst. The serology (immunoblot) for Echinococcus sp. was positive (21 and 31 kDa bands). This case is the first reported in Rondônia, suggesting the need to investigate the polycystic echinococcosis in individuals with hepatic cysts from areas of tropical forest and hunting habits where wild life was present as wild dogs, cats and rodents, particularly Agouti paca (paca) and Dasyprocta aguti (agouti).

Several cases of hydatid echinococcosis were diagnosed in a laboratory colony of 19 pig-tailed macaques (Macaca nemestrina) at the Paul Ehrlich Institute, Germany. Three hydatid cysts were found in the liver of an euthanized animal. The diagnosis of an Echinococcus granulosus infection was confirmed by histopathology and the results of a specific polymerase chain reaction. The serum of five of 14 other monkeys tested for Echinococcus antibodies using a genus-specific enzyme-linked immunosorbent assay (ELISA) was positive or weakly positive; none of the animals, however, showed specific reactions in a E. multilocularis-specific ELISA. On ultrasonographic examination, alterations in the liver were found in four of the serologically positive monkeys, and two animals showed clinical signs such as progressive anorexia, apathy and icterus. The monkeys had most probably acquired the E. granulosus infection in their breeding colony in Slovenia.

A 56-year-old man, from Turkey, with upper abdominal pain and nausea had an echinococcal cyst in the liver.

Infection with the fox dwarf tapeworm, Echinococcus multilocularis, has for the first time been found in a fox in Denmark, and E. multilocularis infection is therefore now a possible diagnosis in Danish patients. This paper reviews the life cycle, epidemiology, clinical symptoms, diagnosis, and treatment of E. multilocularis infections.

Our group at Asahikawa Medical College has established differential serodiagnosis for zoonotic larval cestodiases such as alveolar echinococcosis (AE), cystic echinococcosis (CE) and neurocysticercosis (NCC) using purified specific antigens. In this brief review, we introduce (a) four imported CE cases in Japan, easily identified serologically, (b) most recent advances in serology for differentiation of AE and monitoring of prognosis of AE in Japan. It includes application of affinity purified Em18 and prototype of a recombinant Em18 antigen. Serology using affinity purified Em18 antigens is showing much higher sensitivity for detection of AE cases which are usually undetectable by the ongoing serology for AE authorized in Hokkaido, Japan. As serology for AE, CE or NCC is still not popular in the majority of Asian countries, we expect that this review paper stimulates researchers who are interested in serology or serodiagnosis for these larval cestodiases including AE, CE and NCC.

The Echinococcus Western Blot IgG (LDBIO Diagnostics, Lyon, France), using a whole larval antigen from Echinococcus multilocularis, was evaluated for serodiagnosis and differentiation between two human parasitic infections of worldwide importance: cystic echinococcosis, due to Echinococcus granulosus, and alveolar echinococcosis, due to E. multilocularis. Fifty and 61 serum samples from patients with cystic and alveolar echinococcosis, respectively, were used for assessing diagnostic sensitivity. The sensitivity of the assay was compared with those of screening tests used for these applications. Sera used for assessing cross-reactivities were from 154 patients with other diseases, either parasitic or not. The assay allowed the detection of serum immunoglobulin G antibodies in 97% of Echinococcus-infected patients. It had a higher sensitivity than screening assays for the detection for each echinococcosis. The assay allowed us to correctly distinguish between E. granulosus- and E. multilocularis-infected patients in 76% of cases. It did not allow us to distinguish active from inactive forms of both echinococcoses. The occurrence of cross-reactivities with neurocysticercosis indicates the necessity for retesting sera with species-specific antigens, for rare patients with neurologic disorders. This study shows the usefulness of the commercially available Echinococcus Western Blot IgG for the serological confirmation of human echinococcosis.